Electronic Data Interchange (EDI) Simplifying electronic claims submission
What is EDI?
Electronic data interchange (EDI) is a powerful tool for increasing office productivity and improving cash flow. The benefits of the EDI services offered by AmeriHealth include:
- Faster processing and timely error reporting for claims
- Automated posting of claim payments
- Real-time verification of a patient’s coverage and cost-sharing responsibility
Getting started with EDI
To start conducting EDI business with AmeriHealth, please take the following steps:
- Get your NPI and register it with AmeriHealth.
- Select a trading partner or sign up as your own trading partner.
- Affiliate your NPI with your trading partner to enable electronic transactions.
Platform transition news
As part of our transition to a next generation platform, we are transitioning EDI transactions from the Highmark EDI Gateway to Smart Data Solutions (SDS) Stream Clearinghouse. The transition will be done in phases starting in November 2023. Our goal is to transition all Trading Partners to SDS by the end of second quarter 2024.
For existing trading partners to SDS
SDS will contact existing trading partners when it is time to begin the transition process.
For new Trading Partners to SDS
Visit the new Trading Partner Business Center for an overview of the registration process and to review the Trading Partner Registration Guide. You will receive a verification code from SDS when it is time to start your transition.
For Trading Partners that have not yet completed the transition
Highmark, Inc. (Highmark) currently provides the Highmark EDI Gateway to handle EDI transactions on behalf of AmeriHealth. Please use the information below for assistance until your transition to SDS is complete.
The Trading Partner Business Center is Highmark’s online resource that provides tools and documentation for conducting EDI business.
For questions related to conducting EDI business with AmeriHealth via the Highmark Gateway, please call Highmark EDI Operations at 1-800-992-0246. Highmark EDI Operations is available Monday through Friday, 8 a.m. – 5 p.m., ET.
Upcoming EDI Gateway transition
Over the next year, AmeriHealth HMO, Inc. and AmeriHealth Insurance Company of New Jersey will transition Electronic Data Interchange (EDI) transactions from the Highmark EDI Gateway to Smart Data Solutions (SDS) Stream Clearinghouse.
This is an initial step of our transition to a next generation platform that will help us operate more efficiently and deliver new and innovative products and services. Learn more.
If you have any questions, please email us at firstname.lastname@example.org.